ICD-10 Q&A: Coding Diabetes
Question: I’m seeing a lot of physicians assigning diabetes with hyperglycemia for... “uncontrolled” diabetes. Somehow this doesn’t seem right. Could someone explain to me what the criteria for hyperglycemia is?
Answer: Hyperglycemia has no strict definition and varies from patient to patient in different situations. Anything over a blood glucose over 100 can be considered “hyperglycemia”. In practice, a diabetic patient with blood glucose consistently around 120 and up is usually called hyperglycemic by most providers. Anything over 150 is pretty clear cut hyperglycemia in most cases. So it’s really a subjective diagnosis by the provider. If they call it, we code it.
Avoiding the “controlled/uncontrolled” nomenclature and instead using “hyperglycemia” is preferable for clinicians and for coders. “Uncontrolled diabetes” implies a stigma on the patient and/or provider that they are not doing something right. “Poorly controlled diabetes” is often used but of course must be coded as controlled diabetes, which doesn’t really tell the story correctly. “Hyperglycemia” is based more simply on the blood glucose level and more appealing to providers.
In ICD-10 the concept of “not stated as uncontrolled” vs. “uncontrolled” has been replaced by “diabetes” vs. “diabetes with hyperglycemia”. I think that’s a good thing for all.
SENIOR MANAGING CONSULTANT OF HIM OPTIMIZATION FACILITY CODING FOR HEALTHCARE RESOURCE GROUP, INC.
Ed O’Beirne PA, MHS, CCS, CDIP is an ICD-10 educator of providers and coders with a specialization in procedure coding ICD-10-PCS and CPT. Before joining HRG, Ed was a director of physician assistants and patient relations for an 80k visit a year ER, a physician assistant in emergency medicine for over 10 years, coding supervisor, auditor and consultant for 9 years and EMT and respiratory therapist for 5 years.